Hajime Ishida

Suppression of Spermatogenesis in Patients with Behçet’s Disease Treated with Cyclophosphamide and Colchicine

Reproductive function was studied in 31 adult male patients with Behçets disease during treatment with cyclophosphamide and/or colchicine for 1 to 64 months. Semen was obtained from 27 patients. Azoospermia or severe oligospermia was found in 13 of 17 patients receiving cyclophosphamide with or without colchicine, whereas the sperm count was almost normal in six patients treated with colchicine alone and in four patients receiving neither drug (control patients). Blood samples were available for 31 patients. The mean follicle-stimulating hormone level among 12 cyclophosphamide-treated patients was significantly higher than that of 6 colchicine-treated patients and 6 control patients. These results indicate that cyclophosphamide impairs spermatogenesis in adult men, whereas colchicine does not.

Endocrine Effects of Cyproterone Acetate in Patients with Prostatic Cancer

Cyproterone acetate was given to patients with stages C and D prostatic cancer and its effect on endocrine parameters was studied. At a daily oral dose of 100 mg. cyproterone acetate induced marked reduction in the size and consistency of tumor, while it caused moderate suppression of serum luteinizing hormone, follicle-stimulating hormone and testosterone levels. Elevation of serum prolactin levels was observed after treatment with cyproterone acetate but was to a lesser degree than that caused by estrogens.

Endocrine Studies in Sertoli-Cell-Only Syndrome

Pituitary-gonadal endocrine functions were studied in 15 patients with Sertoli-cell-only syndrome and a comparison was made with other testicular diseases, such as Klinefelters syndrome. Elevated levels of serum luteinizing hormone as well as follicle stimulating hormone and lowered levels of serum testosterone suggested the existence of Leydig cell failure in addition to germ cell failure. However, the degree of these endocrinological abnormalities in patients with Sertoli-cell-only syndrome was mild compared to that in patients with Klinefelters syndrome. Reserve capacity of Leydig cells in patients with Sertoli-cell-only syndrome was considered to be preserved as suggested by the human chorionic gonadotropin stimulation test.

Changes in renal blood flow after treatment with ESWL in patients with renal stones. Studies using ultrasound color Doppler method

Recently several authors have observed tissue damages in ESWL treated kidneys, such as interstitial hemorrhage and edema, cavitation of renal tubular cells and vascular spasms. Examination using renal scintigraphy suggested that these damages could cause a decrease of renal blood flow in the treated kidney. Trying to confirm and further investigate this possibility, we studied on changes of renal blood flow velocity using ultrasound color doppler method in 23 consecutive patients with renal stones who underwent ESWL. The studies were conducted before, immediately after and 1 week after an ESWL treatment. Results were as follows; renal blood flow velocity decreased significantly in the area exposed to shock were immediately after the treatment and returned to the pretreatment levels after 1 week. The changes were not significant in the non-exposed area. In parallel with this decrease of renal blood flow velocity, significant increases of resistive index, pulsatility index and significant decreases of ratio were observed. These parameters calculated by measuring of renal blood flow velocity are known to well correlate with parenchymal vascular resistance. We speculate that these changes in renal parenchymal blood flow velocity are triggered by the tissue damages caused by the exposure to shock wave. The recovery of renal blood flow velocity may depend on the recovery of the tissue damages. Ultrasound color doppler method may make it possible to monitor the recovery of tissue damages induced by shock wave and may provide us with an useful information to determine when to repeat ESWL if needed.

Effects of estrogens on the testosterone levels of peripheral and spermatic vein blood in patients with prostatic cancer.

The mean testosterone levels of peripheral and spermatic vein blood in 16 patients with prostatic cancer who did not have estrogen therapy were 418.2 plus or minus 30.8 ng./dl. (mean plus or minus standard error) and 39.7 plus or minus 5.6 micrograms/dl., respectively. There were 13 patients with prostatic cancer who received estrogen therapy with daily doses of 30 mg. hexesterol or 300 mg. diethylstilbestrol diphosphate and who had decisive decreases of testosterone levels in peripheral (90.1 plus or minus 23.2 ng./dl.) and spermatic vein blood (3.3 plus or minus 1.2 migrogram/dl.). The rate of reduction of testosterone by estrogen therapy was one-tenth in the spermatic vein blood, while that in the peripheral blood was one-fifth. These data indicate that continuation of oral estrogens of these doses is sufficient to suppress the testicular androgens. On the other hand, the spermatic testosterone concentration was about 40 times higher than the peripheral testosterone concentration in patients receiving estrogen treatment. This result suggests that testosterone still is secreted from the testes under large therapeutic doses of estrogens.

Carcinoma in Situ of Germ Ceils and Subsequent Development of an Invasive Seminoma in a Hyperprolacti-naemic Man

A 25-year-old man was first seen complaining of impotence and found to have a pituitary tumour and hyperprolactinaemia. Both testes were small and atrophic, but a testicular tumour was not apparent. Biopsy of the right testis was performed, and the pathology report described thickening of the seminiferous tubule walls and impaired spermatogenesis. The patient refused to undergo an operation for his pituitary tumour and was lost to follow-up. 5 years later, the same patient presented with enlargement of his right testis, and this and the pituitary tumour were excised. The testicular tumour was classified as seminoma, and the pituitary tumour as an adenoma with low malignancy. Re-examination of the previous specimen of his right testis revealed foci of carcinoma-in-situ. This is an additional example of the growth of an invasive germ cell tumour from non-invasive carcinoma-in-situ of the testis.